Reasons and results of endoscopic surgery for prolactinomas: 142 surgical cases
- 503 Downloads
We report herein a retrospective analysis of the results of 142 consecutive prolactinoma cases operated upon using an endoscopic endonasal trans-sphenoidal approach over a period of 6 years.
Medical records of 142 cases were analysed with respect to indications for surgery, duration of hospital stay, early remission rates, failures and recurrence rates during a median follow-up of 36 months.
On the basis of magnetic resonance imaging (MRI) data, 19 patients (13.4 %) had microadenoma, 113 (79.6 %) had macroadenoma, and the remaining 10 (7.0 %) had giant adenomas. Cavernous sinus invasion was identified in 25 patients by MRI and confirmed during surgery. Atypical adenoma was diagnosed in 16 patients. Sparsely granulated prolactin adenoma was identified in 99 patients (69.7 %). Our results demonstrate that male sex and higher preoperative prolactin levels are independent factors predicting persistent disease. The post-surgical complications are as follows: 2.8 % patients had meningitis, 2.1 % patients had postoperative cerebrospinal fluid leak and 2.1 % patients had panhypopituitarism. At the end of follow-up, 74.6 % patients went into remission. During follow-up period, five patients who had initial remission developed recurrence.
Our series together with literature data suggest that an endoscopic endonasal trans-sphenoidal approach in the treatment of proloctinomas has a favourable rate of remission. According to the findings of this study, endoscopic endonasal trans-sphenoidal surgery might be an appropriate therapy choice for patients with prolactinoma who could not have been managed with recommended therapeutic modalities.
KeywordsAtypical prolactin adenoma Endoscopic endonasal trans-sphenoidal pituitary surgery Pituitary apoplexy Prolactinoma Sparsely granulated prolactin adenoma
We are thankful to Mr. Khawar Ali for his contributions to English language editing of this manuscript.
Compliance with ethical standards
For this type of study formal consent is not required.
No funding was received for this research.
Conflicts of interest
- 4.Amit Kumar Thotakura AK, Mohana Rao Patibandla MR, Manas K. Panigrahi MK, Gokul Chowdary Addagada GC (2015) Predictors of visual outcome with transsphenoidal excision of pituitary adenomas having suprasellar extension: a prospective series of 100 cases and brief review of the literature. Asian J Neurosurg. doi:10.4103/1793-5482.149995Google Scholar
- 31.Lloyd RK, Young WF Jr, Farrel WE, Asa SL, Trouillas J, Kontogeorgeos G, Sano T, Scheithauer BW, Horvath E (2004) Pituitary tumors: introduction. World Health Organization classification of tumours. Pathology and genetics of tumours of endocrine organs. IARC Press, LyonGoogle Scholar
- 40.Raverot G, Wierinckx A, Dantony E, Auger C, Chapas G, Villeneuve L, Brue T, Figarella-Branger D, Roy P, Jouanneau E, Jan M, Lachuer J, Trouillas J, Hypopronos (2010) Prognostic factors in prolactin pituitary tumors: clinical, histological, and molecular data from a series of 94 patients with a long postoperative follow-up. J Clin Endocrinol Metab 95:1708–1716CrossRefPubMedGoogle Scholar
- 45.Schwartz TH, Stieg PE, Anand VK (2006) Endoscopic transsphenoidal pituitary surgery with intraoperative magnetic resonance imaging. Neurosurgery 58:ONS44-51Google Scholar
- 48.Steinmeier R, Fahlbusch R, Ganslandt O, Nimsky C, Buchfelder M, Kaus M, Heigl T, Lenz G, Kuth R, Huk W (1998) Intraoperative magnetic resonance imaging with the magnetom open scanner: concepts, neurosurgical indications, and procedures: a preliminary report. Neurosurgery 43:739–747CrossRefPubMedGoogle Scholar